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People & committees
Rep. Bentz, Cliff [R-OR-2] · R–OR
Legislative record
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Referred to the House Committee on Energy and Commerce.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 13, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-10-01 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed IMD CARE Act would let states choose Medicaid coverage for certain services for adults ages 21–64 receiving care in institutions for mental diseases. Eligible adults would need Medicaid enrollment and at least one qualifying mental disorder. Payments under this option would cover no more than 30 days of services per person in a 12-month period. Participating states would have to preserve community-care funding and meet requirements for screening, treatment and transitions back to the community.
This Act may be cited as the Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act or the IMD CARE Act.
a State may elect, through a State plan amendment, to provide medical assistance for items and services furnished to an eligible individual who is a patient in an institution for mental diseases in accordance with the requirements of this subsection.
but only to the extent that such services are furnished for not more than a period of 30 days (whether or not consecutive) during such 12-month period.
(A) Eligible individual The term eligible individual means an individual who— (i) with respect to a State, is enrolled for medical assistance under the State plan or a waiver of such plan; (ii) is at least 21 years of age; (iii) has not attained 65 years of age; and (iv) has at least 1 mental disorder defined in the most recent version of the American Psychiatric Association Diagnostic and Statistical Manual.
maintain on an annual basis a level of funding expended by the State (and political subdivisions thereof) from non-Federal funds for items and services (including services described in subparagraph (B)) furnished to eligible individuals in outpatient and community-based settings that is not less than the level of such funding for such items and services for fiscal year 2023.
As a condition for a State receiving payments under section 1903(a) for medical assistance provided in accordance with this subsection, the State shall carry out each of the requirements described in subparagraphs (B) through (J).
Section 2 would create an optional change to a state's Medicaid plan for calendar quarters beginning on or after January 1, 2027. States would not be required to adopt it.
With respect to calendar quarters beginning on or after January 1, 2027, a State may elect, through a State plan amendment, to provide medical assistance for items and services furnished to an eligible individual who is a patient in an institution for mental diseases in accordance with the requirements of this subsection.
Eligibility would require enrollment in the state's Medicaid plan or a waiver of that plan, age 21 through 64, and at least one mental disorder listed in the latest American Psychiatric Association diagnostic manual. Although the provision's heading refers to serious mental illness, its eligibility definition does not expressly add a severity requirement.
(m) State plan amendment option To provide medical assistance for individuals with a serious mental illness who are patients in certain institutions for mental diseases
(A) Eligible individual The term eligible individual means an individual who— (i) with respect to a State, is enrolled for medical assistance under the State plan or a waiver of such plan; (ii) is at least 21 years of age; (iii) has not attained 65 years of age; and (iv) has at least 1 mental disorder defined in the most recent version of the American Psychiatric Association Diagnostic and Statistical Manual.
Payments under the new option would be subject to the bill's funding and care requirements and limited to 30 days of services per eligible person during a 12-month period. Those days would not have to be consecutive.
Subject to paragraphs (3) and (4), amounts expended under a State plan amendment under paragraph (1) for services described in such paragraph furnished, with respect to a 12-month period, to an eligible individual who is a patient in an institution for mental diseases shall be treated as medical assistance for which payment is made under section 1903(a), but only to the extent that such services are furnished for not more than a period of 30 days (whether or not consecutive) during such 12-month period.
While using the option, a state would have to maintain annual state and local spending from nonfederal funds on outpatient and community services for eligible people at no less than its fiscal year 2023 level. This would be a condition of receiving payments.
As a condition for a State receiving payments under section 1903(a) for medical assistance provided in accordance with this subsection, the State shall (during the period in which it so furnished such medical assistance through a State plan amendment under this subsection) maintain on an annual basis a level of funding expended by the State (and political subdivisions thereof) from non-Federal funds for items and services (including services described in subparagraph (B)) furnished to eligible individuals in outpatient and community-based settings that is not less than the level of such funding for such items and services for fiscal year 2023.
The community-service funding requirement would include outpatient mental health and substance use treatment, care coordination, peer support, medication treatment, crisis services, recovery support, employment and housing support, community clinics, and medication monitoring. The Secretary could designate other outpatient and community services.
(i) Outpatient and intensive outpatient mental health and co-occurring substance use disorder services, including case management and care coordination services. (ii) Assertive community treatment. (iii) Peer support and counselor services. (iv) Outpatient medication-assisted treatment, related therapies, and pharmacology. (v) Crisis mental health services and substance use disorders services including 24 hours mobile crisis teams, crisis receiving and crisis stabilization including specialized programs for in-home stabilization for children and adolescents. (vi) Psychiatric rehabilitation encompassing recovery support, supported employment and supportive housing. (vii) Services furnished by certified community behavioral health clinics and community mental health centers. (viii) Routine monitoring of medication adherence. (ix) Medication to treat mental illness. (x) Other outpatient and community-based services as designated by the Secretary.
Before its plan change could be approved, a state would have to report information needed to verify compliance with the community-funding requirement. The Secretary would have to establish the reporting process within 12 months after enactment.
Prior to approval of a State plan amendment under this subsection, as a condition for a State receiving payments under section 1903(a) for medical assistance provided in accordance with this subsection, the State shall report to the Secretary, in accordance with the process established by the Secretary under clause (ii), the information deemed necessary by the Secretary under such clause.
Not later than the date that is 12 months after the date of enactment of this subsection, the Secretary shall establish a process for States to report to the Secretary, at such time and in such manner as the Secretary deems appropriate, such information as the Secretary deems necessary to verify a State’s compliance with subparagraph (A).
States would have to require providers, managed care plans and care-review organizations to use evidence-based placement and care-management standards developed through stakeholder consensus. Screening before institutional services and initial and periodic assessments would address the appropriate care level, length of stay and setting. States would report their implementation approach to the Secretary.
The State shall require providers, managed care plans, and utilization review entities to implement specified evidence-based, individual placement criteria and utilization management approaches developed by stakeholders using a consensus-based process to ensure placement of eligible individuals in an appropriate level of care, including criteria and approaches to ensure that eligible individuals receive appropriate evidence-based clinical screening prior to being furnished with items and services in an institution for mental diseases, including initial and periodic assessments to determine the appropriate level of care, length of stay, and setting for such care for each individual. The State shall notify the Secretary at such time and in such form and manner as the Secretary shall require how the State will require and implement such placement criteria and utilization management approaches.
Institutional placements would have to support a successful return to the community, considering proximity to family, employment, counseling and other parts of the person's support network.
a placement in such institution for mental diseases would allow for an eligible individual’s successful transition to the community, considering such factors as proximity to an individual’s support network (such as family members, employment, and counseling and other services near an individual’s residence)
States would have to connect patients with community providers before discharge, either by covering those providers' services during the institutional stay or by encouraging institutions to hire peer support specialists. Institutions would also have to assess housing access and connect patients with providers that coordinate housing services.
enrollees are connected with community-based providers as they prepare to transition out of an institution for mental diseases by covering services provided by these community-based providers to enrollees while they are still residing in the institution for mental diseases or by encouraging institutions for mental diseases to hire peer support specialists to assist with the transition and discharge process and ensure enrollees are connected with providers and other resources in their communities after they leave the institution
institutions for mental diseases assess whether enrollees have access to housing as they are transitioning out and connect such individuals with community providers that coordinate housing services
Institutions serving patients covered under the state plan would have three alternatives for supporting less intensive care: provide it themselves; maintain a relationship with a provider that offers it and accepts Medicaid patients; or implement protocols requiring contact within 72 hours after discharge and access to and engagement in follow-up care.
all institutions for mental diseases that furnish items and services to individuals for which medical assistance is provided under the State plan— (I) are able to provide care at such lower level of clinical intensity; (II) have an established relationship with another facility or provider that is able to provide care at such lower level of clinical intensity and accepts patients receiving medical assistance under this title such that the institution for mental diseases may arrange for individuals to receive such care from such other facility or provider upon transitioning out of that institution for mental diseases; or (III) ensure implementation of protocols requiring that contact is made by the institution for mental diseases with each discharged beneficiary within 72 hours of discharge and to ensure access to and engagement in follow-up care.
States would need a process to review institutions' compliance with state program standards covering licensing, audits, reviews of care use and federal program-integrity requirements.
The State shall have in place a process to review the compliance of institutions for mental diseases with such program standards specified by the State encompassing licensing requirements, auditing processes, utilization review processes and Federal program integrity requirements.
States would have to require institutions to screen patients for accompanying physical health conditions, substance use disorders and suicidal thoughts. Identified accompanying conditions would require treatment on-site or through local provider partnerships.
The State shall implement a requirement that institutions for mental diseases also screen enrollees for co-morbid physical health conditions and substance use disorders and suicidal ideation and provide for treatment either on-site or via partnerships with local providers for any identified co-occurring conditions.
A state's application would need an assessment of available outpatient and community behavioral health services for Medicaid enrollees at each care level, including regional differences. An update would be due within 12 months after the state starts the assessment.
The State shall, as part of its application for approval of a State plan amendment described in this subsection, complete and submit an assessment of the availability of outpatient and community based behavioral health services for individuals enrolled under a State plan under this title (or waiver of such plan) in each level of care, including how such availability varies by region of the State.
The State shall complete an update of such assessment described in clause (i) not later than 12 months after date the State commences such assessment.
In succeeding years, states would have to consult with the Secretary about financing plans to expand the listed outpatient and community services where feasible.
The State shall consult with the Secretary in succeeding years regarding financing plans to increase the availability of services listed in paragraph (3)(B) where feasible.
States would have to adopt strategies to improve information sharing across providers and care settings, and to better track available treatment beds, crisis-stabilization beds and mental health providers accepting new patients.
The State shall implement strategies to improve data-sharing between different types of providers (such as mental health, substance use disorder, and physical health providers) and different settings of care (such as hospitals, emergency departments, crisis stabilization providers, community-based treatment providers) as well as strategies to improve the State’s capacity to track availability of treatment and crisis stabilization beds and capacity of mental health providers to accept new patients.
States would have to adopt strategies aimed at reducing emergency-department use by enrollees with serious mental illness who primarily need mental health treatment. These would include supporting peer assistance and psychiatric consultants in emergency departments to connect patients with services.
The State shall implement strategies to decrease use of emergency departments by enrollees with serious mental illness primarily in need of mental health treatment, including by supporting peer supports and psychiatric consultants in emergency departments to improve connections with services and resources.
States would have to take steps to integrate mental health and substance use treatment into schools, primary care and emergency departments. They would also need strategies for earlier identification and treatment engagement among young people with serious mental health conditions, including education and employment support programs.
The State shall take actions to increase integration of mental health and substance use disorder treatment in non-specialty care settings including schools, primary care practices, and emergency departments as well as additional strategies to support earlier identification and engagement in treatment among youth with serious mental health conditions including through supported education and supported employment programs.
The new payment option and its limits would be additional to existing authority for monthly per-person payments to managed care organizations for patients in these institutions. The proposal would not limit or replace that authority under the cited regulation.
Payments for, and limitations to, medical assistance furnished in accordance with this subsection shall be in addition to and shall not be construed to limit or supersede the ability of States to make monthly capitation payments to managed care organizations for individuals receiving treatment in institutions for mental diseases in accordance with section 438.6(e) of title 42, Code of Federal Regulations (or any successor regulation).
Using the new option would not itself prohibit federal Medicaid funding for other covered items or services provided to the person inside or outside the institution during the same period.
The provision of medical assistance for items and services furnished to an eligible individual who is a patient in an institution for mental diseases in accordance with the requirements of this subsection shall not prohibit Federal financial participation for medical assistance for items or services that are provided to such eligible individual in or away from the institution for mental disease during any period in which the eligible individual is receiving items or services in accordance with this subsection.
The proposal would use the existing statutory definition of an institution for mental diseases. It would also add a reference to the new option in section 1905(a), but the surrounding existing law and the institution definition are not reproduced.
in section 1905(a), in the subdivision (B) that follows paragraph (32), by inserting or section 1915(m) after described in section 1915(l)
The term institution for mental diseases has the meaning given that term in section 1905(i).
The amendments would not be interpreted as encouraging inpatient or residential placement when home or community care would be more appropriate. They also would not prevent states from pursuing section 1115 demonstration projects to improve access and care quality for enrollees with serious mental illness or serious emotional disturbance.
Nothing in the amendments made by subsection (a) shall be construed as encouraging a State to place an individual in an inpatient or a residential care setting where a home or community-based care setting would be more appropriate for the individual, or as preventing a State from conducting or pursuing a demonstration project under section 1115 of the Social Security Act to improve access to, and the quality of care for enrollees with serious mental illness or serious emotional disturbance.
The supplied official-actions snapshot, updated October 13, 2026, records introduction in the House and referral to the House Committee on Energy and Commerce on October 1, 2026. It does not establish subsequent legislative action or enactment.
Source snapshot updated 2026-10-13T16:40:41Z. 2026-10-01: Referred to the House Committee on Energy and Commerce. 2026-10-01: Introduced in House
A closer look
Reviewed version: Introduced in House · 2026-10-01. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy rider was identified in the complete supplied introduced text. This conclusion does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place was identified in the complete supplied introduced text. This conclusion is limited to that version; formal earmark status cannot be fully assessed without accompanying materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow carve-out, special exemption or preferential treatment warranting a finding was identified in the complete supplied introduced text. Ordinary program eligibility is not treated as a targeted benefit. This conclusion does not extend to other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Oct 13, 2026. How PlainBill uses AI